Organ Trading

The Article:

ORGAN TRANSPLANTS

BY JENNIFER YEO

& MADAN MOHAN

FOR THE STRAITS TIMES



ACCORDING to the National Kidney Foundation (NKF), 2,343 patients were undergoing subsidised dialysis as of March this year. Last year, only 86 patients received kidneys from live donors. Clearly, an organ market would help alleviate the shortage.

Though the traditional altruistic view rejects one outright, interestingly, the legal framework seems to offer compelling justification for legalising such a market that involves consenting adults. This is because the legal status of the human body is unclear in law.

The courts in different common law jurisdictions have primarily evoked either the law of property or the law of privacy to justify disputes relating to the human body. But common law jurisprudence in this matter has been inconsistent.

Abortion, prostitution and homosexual acts are legal in some jurisdictions. In Singapore, abortion is legal in the first 24 weeks of pregnancy on the written consent of the mother. There are also licensed brothels here with mandatory periodic health checks of sex workers. However, Section 377A of the Penal Code criminalises sodomy between two males.

In, say, the United States and Britain, homosexual acts between consenting adults are legal. There are also surrogate mothers who reportedly charge considerable sums for their services. Moreover, ova, sperm and blood can be sold in many such jurisdictions.

Clearly, law tends to reflect transformed social realities and individual choices, irrespective of the argument based on traditional morality. Thus, legalising abortion, which is unethical for some, was expedient in Singapore's altered socio-economic circumstances. It helped prevent deaths from backstreet abortions in many cases. Similar arguments may also be made for legalising prostitution.

While altruists say that any sale of organs is unethical because of what someone has called "their intrinsic, ineliminable, ineluctable value of human life and health", we need to put ourselves in the shoes of the patient waiting desperately for an organ.

Someone has written poignantly that "the endurance of thrice-weekly dialysis for three to four hours a session, the insertion of two 15-gauge needles into arm or thigh, is a painful reminder of how death is not a problem to be solved, but merely averted, on a day-to-day basis".

Yet the Human Organ Transplant Act (Hota) criminalises any organ donation if it is based on some "valuable consideration". What if two adults of sound mind, out of their mutual needs, enter into an agreement for helping each other: one offering his kidney and the other offering cash needed, say, for the education of the donor's son or urgent discharge of a debt?

Is it fair to criminalise such social relationships where no third party is harmed? When a social relationship is forged which gives a new lease of life to both the stakeholders, then law ought not to step in to criminalise and punish such relationships.

Humaneness suggests not just the protection of the poor, weak and sick from exploitation but also that society helps them out of their destitution and suffering whether caused by poverty or disease.

Organ donation, even if it involves valuable consideration, may make life better for both parties who find no way out of problems of health or poverty. If the State – and the altruists – cannot help the poor in overcoming their problems, it ought not to raise more barriers for them.

A legal market can be regulated whereas present practices cannot. While international opinion is currently against any trade in human organs, Singapore can take the lead and set a good precedent for the international community by legalising it. The Republic has the infrastructure to facilitate such transactions.

One idea is to set up a kidney registry for registering and screening donors and recipients to find matches and ensure that there has been no coercion, duress or exploitation. A charitable foundation or independent administrative body could take care of this and related matters such as informed consent, protection of identities of donors and donees, requirements, medical bills, insurance, compensation and benefits for donors, their families and other post-transplant issues.

As potential donors could include foreigners, it is not beyond consideration that foreigners might also be allowed access to the registry if they meet the criteria and safeguards.

Transplants in Singapore should be carried out only in a safe and controlled environment between donors and donees who have undergone thorough screening by the central registry.

We could study the Iranian model which facilitates kidney donations for their citizenry, adopt what works for us with modifications necessary in our local context and implement the necessary safeguards.

With Singapore being the fifth highest in the world in terms of incidence of kidney failure, it is time for the Government to revisit Hota to allow organ transplants where the donors can be compensated with cash and other benefits.

The writers practise law at Yeo-Leong and Peh LLC.

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The Commentary:

The recent comments made by Health Minister Khaw Boon Wan on organ trading have sparked a widely contested debate. This article by Madam Mohan and Jennnifer Yeo tells us why organ trading should indeed be legalized. They also tell us that Singapore should set an example – implementing organ trading in a judicious and effective way.

Being lawyers themselves, they gave us the legal point of view. They talked about the how the ‘legal status of the human body is unclear’ – and that certain acts like abortion were legalized so as to prevent death. They put forth the benefits of legalizing organ trading in terms of social context

I feel that some of the arguments put forth are assumptions and not exactly valid. Take, for example, the argument that organ trading can bring the poor to richness. Is this really the case for all? I beg to differ. We have to remind ourselves that many are forced and simply bullied into trading their organs, and some forced due to debt. For example, an Indonesian man was blatantly forced to ‘donate’ his kidney just because he owed someone $2000. It is indeed true that organ trading can improve conditions of the poor. However, they fail to realize that this is never always the case.

It is indeed true that waiting for an organ can be long and painful – "insertion of two 15-gauge needles into arm or thigh, is a painful reminder of how death is not a problem to be solved, but merely averted, on a day-to-day basis". But organ trading does not definitely confirm the loss of these troubles. With advanced technology, many would brush off the possibility of an organ transplant failure, or side effects. However, this is something we cannot ignore because organ rejection and complications can always arise. And with this, the quality of life is not guaranteed. Here is yet another assumption made.

The legalization of organ trade is also said to increase accessibility of organs for patients. On the contrary, human nature, for the sole purpose of survival, is selfish and calculating. This explains the actions of the buyer and the seller. For survival, humans will do practically anything, and this means the concept of organ donation would soon become extinct. Let me give you this scenario: If organ trading was legalized, and you were a suitable kidney donor, would you rather sell your kidney, or simply donate it? The answer is obvious for most. Moreover, if a dying patient needs a kidney transplant, and did not have enough money, he would just have to die slowly. As such, organ trading does not help the patient; it merely helps those who seek profit and those who have the means to buy organs.

In conclusion, I feel the above article epitomizes the shallow perspective on organ trading. It reduces the difficulty of implementation and makes assumptions on the benefits of organ trading. As such, I feel that organ should not be legalized, contrary to what was mentioned above.

Does Democracy really create stability in a society?

Democracy is a form of political governance, and in the real world comes in many forms. In this commentary, democracy shall be defined as “a government elected by the people” (Oxford Dictionary). Stability too comes in different forms and I shall focus on social stability for this commentary.

Democracy allows expression by various groups, and when operated properly, allows for representative views and a basis for peaceful co-existence. It allows for buy-in and ownership of decisions. Yet, democracy, though used widely as forms of governance in countries, has its flaws. Though widely promoted as the ‘near perfect’ governing system, and recommended as the system of choice by the UN, it has its failures. Moreover, when it comes to stability, democracy is not the only factor that leads to it. There are many others which also affect stability in a society. Thus, I feel that democracy does not create stability in a society all the time.

One of democracy’s major flaws is its basis on two assumptions. One, that humans have the capacity to make the right and logical decisions (which leads to stability). Two, that humans can make their own decisions, representing themselves only, without influence from any other source. These assumptions make the whole idea of democracy doubtful.

For example, the chaos, fighting and social instability in the Sri Lankan civil war was created by a failed democracy. The Sinhalas had been the ‘lower’ race compared to the Tamils during British rule, despite being the majority. When the British left and Sri Lanka became independent, the Sinhalas voted in a Sinhala leader and supported many policies which greatly disadvantaged the Tamil population. This caused uproar among the Tamils and civil war broke out. The Sinhalas were blinded and influenced by the past and thus made decisions that affected the stability of the country. This clearly is an example the failure of democracy to create stability in a society.

It is true that stability can be obtained by making everyone happy. Some might argue that is more or less what democracy does, thus it creates stability. However, they fail to remember that democracy only satisfies the majority, and an unhappy minority can still cause instability, just as seen in the previous example.

The recent debacle in Thailand can also be explained by a failed democracy. Before Thaksin was voted in the second time, Thais already knew that the people in the south were unhappy with him. They too knew that it would certainly cause conflict if he was given a second term. However, the majority thought that voting him in was right, and thus they did, causing more conflict and social instability. Here, we can see the other assumption in action: that humans have the capacity to make the right decisions.

Clearly, democracy does not create stability per se. It depends on many other factors like the people, and the two assumptions made make the system weak and prone to instability in the given society.

Emo: It just ain't the way to Go

THE ARTICLE:

In following angsty fad, teens cut themselves and write about suicide

BY SANDRA DAVIE

EDUCATION CORRESPONDENT


IF YOU have teenage kids and have not heard of the latest teen fad "emo", it is time you looked it up.

Shops catering to teens say this angst-filled youth sub-culture, called emo, short for "emotional", has been gathering a following here.

It has also left youth counsellors worried if the fad is behind the increasing incidence of teenagers cutting their wrists.

Emo fashion is characterised by teens wearing dark T-shirts, a little undersized or deliberately worn down to look old.

Their choice of sneakers is Converse canvas shoes. Look closer and these might have words like "pain'' scribbled in red ink or a drawing of a broken heart.

But the defining trademark for emo kids has to be the heavily lined eyes and long fringed hair which covers half their face.

The point of that, said emo teen Mervyn Lee, 17, a polytechnic student, is because "we are tortured souls unable to face the world".

Another tell-tale sign – they listen to angst-filled music from bands like Hawthorne Heights, Aiden, The Used, My Chemical Romance and Fall Out Boy, which performed here earlier this month.

Youth counsellors interviewed say they are worried that the fad, carried to extremes, can lead to self-

mutilation or even suicidal thoughts.

As it is, some emo teens have penned poems about suicide and death and slashing their wrists to "ease their pain''.

The trend may be behind the increased incidence of teenagers injuring themselves.

There have been no studies done on how prevalent self-injury is, but five youth counsellors interviewed said they have seen an alarming increase in their young charges cutting themselves.

Anecdotally, it seems more common among girls, and they are getting younger.

Just last month, The Straits Times reported that a group of 12-year-olds in an all-girls primary school made a collective pact and slashed their arms with penknives. The incident came to light after teachers discovered the scars the next morning. The girls were counselled and are being monitored.

Said Dr Carol Balhetchet, Singapore Children's Society director of youth services: "It is okay for kids to follow a fashion. That is very normal. What is worrying is if they start blindly following the other things like cutting themselves and writing poems glorifying their suicide attempts.''

Eight of 12 teens The Straits Times spoke to, who follow emo fashion, admitted as much.

One, an 18-year-old girl from a junior college, said she started cutting herself out of curiosity after listening to songs by an emo rock band.

She said she now does it weekly, but hides the scars from her doctor father and accountant mum.

Another emo teen, an 18-year-old polytechnic boy, said it is part of the fashion.

"It's a form of expression, just like the poems I write. I will go mad if I can't, don't have these forms of release,'' he said.

What is surprising is that most of these angst-filled teens come from stable homes, where their parents are professionals.

When pressed, they admitted there were no issues that were really depressing.

Parents seem clueless. One, Mrs Daisy Lim, 48, a businesswoman, said she had heard her daughter using the word "emo" but never realised it was a teen fad.

Her 16-year-old daughter wears under-sized, worn-out tees over tight black jeans. On weekends, the Secondary 4 girl also wears two lip rings and six earrings on one ear alone.

Mrs Lim recently discovered that her daughter cuts her wrists with a razor. She is trying to get her to seek help.

But counsellors say parents should not overreact.

Said Dr Balhetchet: "They should talk to the kids to find out the extent of it.

"If the child has taken the fad to the extent of harming himself, they should not panic and scream at the child. They should be open to listening him out.

"Then they will find it easier to persuade him to seek counselling help.''

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The article by Sandra Davie talks about the new trend – the ‘emo’ culture. In this article, she studies the trends of the ‘emo’ culture and cites several examples. She identifies the main cause of this ‘emo’ fashion as teenagers feeling hurt, and unable to face the world.

Teens following the emo trend usually wear dark, and slightly undersized or old-looking t-shirts. Another trademark of their appearance is their long-fringed hair and heavily lined eyes. And they choose to wear Converse shoes, sometimes with words like ‘pain’ and drawings of broken hearts. They explained that the emo culture is a ‘form of expression’ of the pain they were going through in this world.

Beyond that, the emo culture is also producing increasing incidences of teens cutting themselves at the wrist. A good example was a group of 12-year old girls who made a pact to slash their wrists. Some even gave the excuse that cutting their wrists facilitated ‘release’ of their emotions.

Now seriously, what is this world coming to?

What I cannot understand is how cutting oneself can allow a release of emotions. Laughter and tears were made for this purpose, not knives and wounds. What I understand, though, is that the emo culture for most is but a frivolous trend that they practise to ‘look cool’. As said in the article, most teens admitted that there were no issues that were really depressing.

I feel that one of the major reasons why more teens are picking up this habit is because of influence from emo rock bands like Fall Out Boy and Chemical Romance. One teenager started cutting herself out of curiosity after listening to a rock band, and now cuts herself weekly. But this is not the reason for the emo culture in entirety. It is indeed true that the media influences teens, but I think it is more of peer pressure that causes teens to pick up the emo culture and habits. When they see more and more of their peers following the emo culture, they feel left out and decide to join in. This snowballing effect thus causes more and more teens to have these emo habits.

It is really disheartening to see our teens, the leaders and adults of future Singapore, following a trend of such frivolity. I feel teenagers should try to discover the purpose of this emo culture, and if they find a lack of one, to stop this at once. Counseling is a good method, but this does not always work. Perhaps others around them can try to accept them as they are, and slowly change their outlook of life. But of course, for both methods to work, the teenager practising emo habits must be open-minded and see the frivolity of the trend he/she is following. The fact is, if one doesn’t help oneself, no one can.

“There’s none so blind as they that won’t see” Swift – Polite conversation

Please, wipe of the lining and just open your eyes.